'When you hear hoofbeats, think of horses not zebras' - the old adage is well-known to GPs but what should you do when faced with a zebra, not a horse? Consultant cardiologist Professor Robert Tulloh and GP Dr Louise Tulloh kick off our new series with their advice on how to catch Kawasaki disease in general practice.

PCTs grant huge rise in manager salaries

Exclusive: PCTs have sanctioned staggering increases in management salary costs, with spending soaring by a quarter in just the past two years, a Pulse investigation reveals.

Many trusts project rises in management costs of 60% or more over the two-year period, with costs at one trust rising by more than 100%.

The steep increases coincide with a period in which investment in primary care has been curtailed and GP pay frozen.

Pulse obtained information from 55 PCTs under the Freedom of Information Act. At those trusts, projected spending on management salaries rose by 25%, from £312m in 2007/8 to nearly £390m in 2009/10.

The increase is partly through trusts taking on increasing numbers of managers, with 15 that provided head counts seeing their number of posts rise by 14% over two years.

But cost per management post also rose steeply, by 11% over two years. By contrast, latest figures show GP pay fell by 1.5% between 2006/7 and 2007/8, while investment in GP practices limped up by just 1.1% between 2007/8 and 2008/9.

NHS Hounslow topped the pile with an enormous 116% increase in manager salary costs over the two years, while at NHS Somerset costs rose by 72%.

Dr Barry Moyse, chair of Somerset LMC, said: ‘All our public services have seen an endless torrent of demands from the centre. Managers have no choice about whether to comply so the need for more managers grows inexorably.'

Mike Penning, Conservative shadow health minister, said: ‘These are shocking increases in the costs of bureaucracy and management within the NHS. It is inevitable the rises must be keeping money away from patient care and the front line.

‘Labour ministers must explain exactly why so much more is being spent on management after a reorganisation of PCTs that was intended to produce efficiency savings.'

The Department of Health said it was ‘for PCTs to determine their management costs' and to ensure they were ‘securing value for money'.

But David Stout, director of the NHS Confederation's PCT network, said: ‘A lot of this is spending trusts are carrying out in response to what the DH has asked for. If you ratchet up expectations on delivery you also ratchet up costs both in the unit cost of existing managers and the overall numbers.'

He admitted it was ‘unrealistic' for such big increases to continue.

NHS North East Essex, which saw costs soar by 26% in the past year alone, blamed the rise on the cost of separating its provider and commissioning arms.

NHS Cornwall, which has seen a 15% increase in costs over two years, said some of the increase had been driven by national schemes such as piloting of Telehealth, requiring entirely new management teams.

Other PCTs were less forthcoming. NHS Surrey, which predicts it will spend around £7.8m on management costs this year, said it was unable to retrieve its earlier costs because they were with a previous supplier, while NHS Solihull claimed to have no projected figures at all.

GPC negotiator Dr Beth McCarron Nash said: ‘GPs are constantly being told by PCTs to make efficiency savings, but maybe it's about time PCTs saved some of this by cutting back on some of these management positions.

‘This has been driven by wave after wave of Government initiatives and it's not surprising so much NHS money has been wasted. What we need now is a period of calm.'

Dr Beth McCarron-Nash: Time PCTs saved money by cutting back on management spending Dr Beth McCarron-Nash: Time PCTs saved money by cutting back on management spending How have manager salaries risen in your area?

To see how PCT spending on manager salaries has risen in your area, check out our interactive map by clicking here.